self management
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Background and Purpose: Self-management Support (SMS) helps stroke survivors control risk factors to prevent second stroke. Little is known about feasibility and effectiveness of using mobile health technology (MHT) for SMS among underserved stroke survivors. The investigators studied feasibility and effectiveness of using a video teleconference mobile application to deliver a SMS program to underserved, hard to reach stroke survivors. Methods: The Video teleconference Self-management TO Prevent stroke (V-STOP) program was evaluated using longitudinal design with measurements at baseline, immediately post intervention (6 weeks), intermediate (12 weeks), and at study end (18 weeks). Medically underserved stroke survivors with uncontrolled stroke risk factors were included. Feasibility was assessed as time in intervention, telehealth satisfaction, stroke knowledge and SMS effectiveness were measured as psychological (depression, PHQ-8; anxiety, GAD-7), social (community integration questionnaire), and stroke self-management (goal attainment) outcomes. Generalized estimating equations were used with site and time in intervention as covariates. Results: V-STOP was successfully delivered to 106 participants using MHT over 2 years. Mean age was 59.3 (±10.9), majority were white (82.1%), males (54.3%), not living alone (85.9%), married (52.8%), with low annual income (<$25,000) ( 58.5%), and health insurance (59.4%). Program feasibility indicated mean number of V-STOP sessions were 4.6 (±1.8), with 4.4 (±2.0) hours of total time for the intervention. Overall satisfaction at 6 weeks with V-STOP (4.8(±0.5)) and telehealth (4.7(±0.5)) was high. Stroke knowledge was high at 12 weeks (9.6(±0.7)). SMS effectiveness indicated improvement in psychological outcomes at 6, 12, and 18 weeks from baseline; depression (18 weeks - β = 0.64 (CI 0.49-0.84)) and anxiety (18 weeks - β = 0.66 (CI 0.51-0.85)). Community integration improved by 18 weeks - β = 1.08 (CI 1.01-1.16) and stroke self-management also improved long term at 12 and 18 weeks (β = 0.92 (CI 0.84-0.99). Conclusion: MHT is feasible to deliver SMS to underserved stroke survivors. It improves psycho-social and self-management goal setting and goal attainment outcomes.

AbstractBronchiectasis is an increasingly common chronic respiratory disease which requires a high level of patient engagement in self-management. Whilst the need for self-management has been recognised, the knowledge and skills needed to do so— and the extent to which patients possess these—has not been well-specified. On one hand, understanding the gaps in people’s knowledge and skills can enable better targeting of self-management supports. On the other, clarity about what they do know can increase patients’ confidence to self-manage. This study aims to develop an assessment of patients’ ability to self-manage effectively, through a consensus-building process with patients, clinicians and policymakers. The study employs a modified, online three-round Delphi to solicit the opinions of patients, clinicians, and policymakers (N = 30) with experience of bronchiectasis. The first round seeks consensus on the content domains for an assessment of bronchiectasis self-management ability. Subsequent rounds propose and refine multiple-choice assessment items to address the agreed domains. A group of ten clinicians, ten patients and ten policymakers provide both qualitative and quantitative feedback. Consensus is determined using content validity ratios. Qualitative feedback is analysed using the summative content analysis method. Overarching domains are General Health Knowledge, Bronchiectasis-Specific Knowledge, Symptom Management, Communication, and Addressing Deterioration, each with two sub-domains. A final assessment tool of 20 items contains two items addressing each sub-domain. This study establishes that there is broad consensus about the knowledge and skills required to self-manage bronchiectasis effectively, across stakeholder groups. The output of the study is an assessment tool that can be used by patients and their healthcare providers to guide the provision of self-management education, opportunities, and support.

Purpose: It is well documented that chronic conditions, such as diabetes, impact quality of life (QoL). QoL assessment is essential when developing and evaluating diabetes self-management education support interventions. The aim of this systematic review was to evaluate the evidence and gaps in the research and the impact of diabetes self-management education (DSME) on QoL outcomes in persons with type 1 diabetes mellitus (T1DM). Methods A systematic review of English language studies published between January 1, 2007, and March 31, 2020, was conducted using a modified Cochrane review method. Studies were included if they were randomized controlled trials (RCTs), participants had T1DM with or without caregivers, a DSME intervention alone or a component(s) of the ADCES7™ Self-Care Behaviors was described, and QoL was a primary or secondary outcome. A 3-tiered review process was utilized for selecting articles. Retained articles were assessed for risk of bias. Results: Nineteen articles, reporting on 17 RCTs, met inclusion criteria, of which 7 studies reported QoL as the primary outcome and 10 as a secondary outcome. Seven studies detected significant impact of DMSE on QoL outcomes in either the participants or family caregivers, which varied in participant populations, selection of QoL tools (generic vs diabetes-specific), intervention type, intervention length, and type of interventionist. Conclusion: DSME has the potential to influence QoL outcomes in people with T1DM. Research using more standardized methods are needed to delineate impact on a broader range of factors that influence QoL for those living with T1DM across the life span and their caregivers.

Purpose: The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. Methods: We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (≥18 years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. Results: Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). Conclusions: The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care.

The evidence-based Diabetes Self-Management Program (DSMP) has been shown to improve a variety of health-related outcomes, but the program has been challenging to implement in rural areas, and rural dissemination has been low. The purpose of this project was to evaluate the effect of implementing the DSMP on self-reported outcomes in a rural region. Through a collaboration with multiple partners, the Living Well program delivered 28 DSMP workshops from 2017 to 2019. Data were collected to determine whether there were post-intervention changes in patient-reported outcomes on measures of diabetes distress, self-management, and patient activation. In addition, secondary analysis of A1C was abstracted from the medical records of participants with type 2 diabetes who completed at least four sessions of a DSMP workshop between 2017 and 2019 and whose medical records had a A1C value in the year before the program and at least one A1C value &gt;3 months after the program. Statistically significant improvements were seen for the Diabetes Distress Scale (P = 0.0017), the Diabetes Self-Management Questionnaire (P &lt;0.0001) and the 10-item Patient Activation Measure (P &lt;0.0001). There was no evidence of change in A1C over time in analyses of all participants (P = 0.5875), but a consistent though nonsignificant (P = 0.1087) decline in A1C was seen for a subset of participants with a baseline A1C ≥8%. This evaluation provides preliminary support for implementing the DSMP as part of a comprehensive treatment and self-management plan for people living with diabetes in rural areas.